PACES

Introduction

PACES is the practical examination part at the end of the MRCP exam course, allowing UK doctors to work as a medical registrar. 

Format

Paces underwent a revision in 2023. The new format has 5 clinical stations of twenty minutes each. Therefore the total exam is 100 minutes or 1 hour 40 mins. 

Summary

• Examination stations x4: one of neurology, respiratory, cardiovascular and abdominal (10 mins each, 40% total time)

• Communication stations x2 (10 mins each, 20% total time)

• Consultation stations x2 (20 mins each, 40% total time)

5 minute breaks

• Communication & examination stations, you required to go into the next station without a break or time to read the blurb

• Consultation stations will have 5 minute of preparatory reading

Examination Stations

Skills assessed:

1. Examination (6 minutes)

   1. • Performance

      • Eliciting signs

2. Discussion (4 minutes)

   1. • Presentation

      • Examiner Questions

Timings

5 minute break: the blurb is usually very short and you'll have no time to prepare when paired with the communication stations. 

10 minute station: 

• Examination 6 minutes

The examination will finish after 6 minutes. For practice I would allow 5 minutes for patients and 4 minutes on friends. The examination should be slick and be able to be completed in that time, however if there is a sign you're unsure of this can really slow you down. 

Examinations Assessed

In this station you'll only be asked to perform:

• Nervous System Examinations: either- cranial nerves, upper limb or lower limb

• Respiratory Examination

• Cardiovascular Examination

• Abdominal Examination

A. Examination Performance

Within the whole of paces, this is the area you know will come up. Therefore there is high examiner expectations that you should be able to complete the examination effectively. There is no excuse for not practicing it until it is second nature. Some of the examination maneuvers can be more difficult when performed with signs. 

B. Eliciting the signs

Arguable the most anxiety provoking part of paces, because there is always the risk of missing a sign. Some examinations may have only one sign (e.g. hepatomegaly) and your whole station can be failed on your inability to elicit the correct signs. In theory they should be clear and obvious. Another difficult is indecision is not tolerated- either there is hepatomegaly or not. Some signs you can mitigate- e.g. there was a systolic murmur, however you should be able to distinguish ejection systolic from pansystolic.

C. Presenting the signs

Paces is an oral exam and the importance of presentation is easily underestimated. I personally believe it is less important when you clearly have the diagnosis, e.g. aortic stenosis but regardless examiners will be impressed by a good structure. It is of paramount importance when you don’t know the answer because a good structure and presentation can show correct working to your examiner and even mask your areas of incompetence. A good generalisation is give the diagnosis if you're confident but if you are not, list the signs and then your differentials. 

D. Examiner Discussion

This is the most unpredictable part of the station and so it can be useful to use up this time with a good presentation. Secondly you may be able to answer your examination’s questions with your presentation which’ll look good and may be easier for yourself. The discussion is primarily to ensure you reached the differentials from your signs, correctly. It can be also useful to practice answering questions you don’t know without sounding useless.

Check our more in depth pages for more information:

• Nervous System Examinations

• Respiratory Examination

• Cardiovascular Examination

• Abdominal Examination

Communication Stations

The communication stations are often felt to be the easiest because of the lack of clinical knowledge required. They are important contributers to the overall mark and pockets of knowledge can be invaluable. 

Timings

• 5 minutes break reading blurb and prepping

• 10 minutes total: all discussion with patient (no examiner questions at the end)

Patient Discussion

• Introduction

• Take it slow, pause, let the patient centre this around their concerns and beliefs

• Summarise

• Thank patient at end

Core topics:

• Explanation of diagnosis or procedure

• Breaking bad news

• Consent, capacity, 

• Confidentiality

• Power of attorney and next of kin

• Complaints procedure, duty of candour, unhappy/ abusive patient or relative

For more information: see Communication Station. 

Consultation Stations

Timings

• 5 minutes prepartory reading

• 20 minute station

  • 15 minutes: patient- history, examination and explanation

  • 5 minute: examiner- presentation and discussion

Strategy

• Prepare structure in 5 minutes preparation

• A detailed, particularly HPC should prompt a good differential and examination

• History should include- PMH, DHx, Allergies, SHx, ICE; systemic enquiry and consider travel, family and pet history

• Know the core 'PACES' presentations well, e.g. phaeochromcytoma

In my opinion, this is the hardest station. Two cases with a lot of marks and incredible breadth and depth of presentations. 

For more information: see Consultation Station. 

References

1. https://www.thefederation.uk/examinations/paces/format

2. https://ptpaces.wordpress.com/

3. https://www.learnhaem.com/courses/mrcp-paces/lessons/hepatomegaly/

Written in 2026.